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A novel contraceptive makes life easier in Uganda and beyond

November 15, 2014 by Fiona Walugembe

How will a small single-dose contraceptive expand family planning choices for women around the world?

Woman on bench in empty clinic space.

A woman waits for health care at a clinic in Uganda’s Mubende District. Photo: PATH/Will Boase.

If you had to walk 14 miles and cross a river to get contraception, you might think twice about how to use your time.

“Do I really need family planning? What are my chances of actually getting pregnant anytime soon? And will it be a long wait at the clinic?”

Add children to the equation. Children who need your attention, now. And the meals that need to be made. After a while, the long walk gets pushed into the background as your day-to-day priorities take over.

So let’s change the equation

What if contraception could be accessed in your village in a simple dose that only required minimal training to administer? And as a bonus, the needle was smaller than the usual shot in the arm.

All of a sudden, making time gets a whole lot easier.

Woman looks on as Sayana Press shot is prepared.

Contraception available closer to where many Ugandan women live. Photo: PATH/Will Boase.

A breakthrough for women

In the PATH office in Kampala, project coordinator Fiona Walugembe works closely with the ministry of health and country partners to implement a project designed to bring family planning choices closer to where women live.

Fiona coordinates Uganda’s pilot introduction of the long-acting, reversible contraceptive called Sayana® Press, a new formulation and presentation of the widely used Depo-Provera®. Sayana Press eliminates the need to prepare a needle and syringe. Instead, the contraceptive is delivered through the single-use Uniject™ injection system (originally developed by PATH). It’s a streamlined design that makes it easier for trained community health workers to safely provide injections in clinics, community locations, or villages.

A woman holds her baby while receiving an injection.

A woman holds her baby while receiving the Sayana Press contraceptive. Photo: PATH/Will Boase.

Due to its design, Sayana Press presents an ideal opportunity to strengthen the capacity and expand the role of community-based health workers called Village Health Teams (VHTs) throughout Uganda.

“This is a breakthrough for women in Uganda. Sayana Press will go a long way in reaching out to women in the most remote areas, especially since injectables are already the most preferred method of family planning choice in Uganda. The fact that it is delivered in the all-in-one Uniject system with a shorter needle will be highly acceptable to the women,” says Fiona.

To date, the PATH team has trained about 260 VHTs in Uganda’s Mubende District, and Pathfinder Uganda has collaborated with PATH to train 100 more in Amuria District. PATH and Pathfinder are training these VHTs on a variety of family planning methods, including Sayana Press. Fiona has seen firsthand that the VHTs take this new opportunity and their responsibilities to their communities very seriously.

“Community health workers have welcomed this new option for women. They appreciate the ease of injection,” says Fiona. “One health worker in Uganda predicted that Sayana Press will expand access (to family planning) for busy young mothers who will now be able to visit a health worker in the community for an injection rather than waiting a long time at a clinic.”

Contraception that’s easy and inexpensive

Injectable contraceptives are a widely used family planning method for women, and have been used around the world for several decades. They are especially popular in developing countries, where the risk for maternal death during childbirth can be as high as 1 in 15. Each injection provides a woman with protection for roughly thirteen weeks (about three months). The downside is that, in many settings, the same woman must often travel to a clinic about every three months to receive each injection.

However, Sayana Press may be more easily administered to women in remote, hard-to-reach areas by health workers like VHTs who have basic training—and potentially for women to administer themselves through self-injection. It’s contraception that’s easy to transport, easy to use, and designed to reach women wherever they live.

A health worker throws away a used injectable.

A health worker throws away a used Sayana Press injectable. Photo: PATH/Will Boase.

What lies ahead

This year Sayana Press was introduced in Uganda, Burkina Faso, and Niger, and Senegal is now following suit. PATH works closely with ministries of health (MOH) and local partners to coordinate these country-led introductions.

Since the program launched in Burkina Faso, approximately 75,000 Sayana Press units have been distributed to health facilities, and approximately 2,500 health care providers have been trained to administer Sayana Press. In Burkina Faso alone, preliminary data shows that more than 5,700 women are using Sayana Press, and over 1,600 of these women are new users of family planning. Data in Uganda are only just starting to come in, but a full report will be available early in 2015.

“By the end of the first quarter of 2015, PATH and Pathfinder together will have trained about 1,200 VHTs in 10 districts of Uganda,” says Fiona. “In the coming year or so, other partners in Uganda, including FHI 360, WellShare, and Marie Stopes Uganda, will train an additional 1,360 community health workers in 19 more districts. It is energizing to see these partners working collaboratively to increase contraceptive options for so many women in Uganda.”

PATH is starting to train VHTs in Gulu District, with a particular focus on ensuring young women can access Sayana Press. Youth-friendly, rights-based family planning is emphasized in all the VHT trainings throughout Uganda. In addition, in Gulu, PATH is supporting the Ugandan affiliate of International Planned Parenthood Federation, Reproductive Health Uganda (RHU), to integrate Sayana Press in their youth-friendly outreach and services.

In early 2015, PATH and the Ugandan MOH will also begin studies to explore how a self-injection program might work, including what support women would need to inject Sayana Press safely and effectively at home.

The potential for Sayana Press is becoming a reality—for the first time

The Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation (CIFF), and Pfizer just announced an agreement that will expand access to Sayana® Press even further, at a new per-dose price of US$1 to qualified purchasers such as procurement agencies like the United Nations Population Fund (UNFPA) or the United States Agency for International Development (USAID). The agreement will help ensure that women in the world’s 69 poorest countries have access to this new contraceptive option at reduced or no cost.

The consortium of public- and private-sector donors and aid organizations supporting this collaboration includes the United Kingdom’s Department for International Development (DfID), UNFPA, and USAID. These partners are playing an important role in ensuring that even more women can access Sayana Press. In addition to assisting with procurement, DFID, UNFPA, and USAID will support country introductions and the delivery of Sayana Press to health facilities.

“It is exciting,” said Fiona. “It is really a big thing.”

As access to Sayana Press increases due to the new product price, the pilot introductions are now even more important. PATH anticipates that this program will provide valuable information to more countries that choose to add Sayana Press to their family planning options under the new initiative. The lessons learned will help take this innovation to scale faster, offering millions more women access to family planning that meets their needs no matter where they live.

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